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Pulmonary Agents

Pulmonary Agents

Diagnosis

1.
Eye and airway irritation, dyspnea, chest tightness, delayed pulmonary edema

2.
Smell of newly mown hay or freshly cut grass or corn

3.
Classification based on H2O solubility

Water soluble: acrolein, NH3, chloramine, HCl, SO2, riot control agents

Rapid onset, easily absorbed in mucous membranes of eyes, nose, oropharynx (very irritating)

Rarely effect lower respiratory tract

Low H2O soluble: NOx, phosgene

Delayed onset, penetrate deeply into lungs causing non-cardiogenic pulmonary edema

Intermediate soluble: both properties of H2O & non-H2O agents

4.
CXR: hyperinflation, pulmonary edema
History

1.
John Davy first synthesized phosgene in 1812

2.
First battlefield use of phosgene at Verdun in 1917 by Germany

3.
Phosgene was not used in WWII
Pathophysiology

1.
Absorbed by inhalation; penetrate to level of respiratory bronchioles and alveoli

2.
Phosgene (CG):

low solubility agent, gas, industrial purposes

CG odor threshold: 1.5 mg/m3; irritates mucous membranes at 4 mg/m3; LCt50 is approx 3200 mg-min/m3

CG 2 x as potent as chlorine

3.
Perfluoroisobutylene (PFIB):

toxic pyrolysis product of tetrafluoroethylene; encountered in military material (e.g. Teflon)

PFIB 10 x more toxic than CG

4.
Oxides of nitrogen (NOx): components of blast weapons or may be toxic decomposition products

5.
Obscurant Smoke (e.g., HC smoke): toxic compounds, cause same effects as phosgene
Isolation/Decontamination

1.
Chemical protective mask

2.
Vapor – fresh air

3.
Liquid – copious water irrigation
Treatment

1.
Terminate exposure

2.
ABCs, supportive measures:

May need PPV with PEEP

IV fliuds for hypotension

Bronchodilators for bronchospasm

3.
Strict bed rest

4.
Steroids in HC smoke

5.
Chlorine: watch for bact. superinfection
Disposition

1.
Admit

2.
Notify CDC & local health dept
Military Detection/Treatment Kits
(See Chemical Agent ID/Detection)

1.
MINICAMS, Monitox Plus, Draeger tubes, Individual Chemical Agent Detector (ICAD), M18A2, M90, M93A1

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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